Healthcare Provider Details

I. General information

NPI: 1104384510
Provider Name (Legal Business Name): LEGACY SKILL NURSING L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 CALLE VICTORIA BARIO TEJAS
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 246
LAS PIEDRAS PR
00771-0246
US

V. Phone/Fax

Practice location:
  • Phone: 787-719-7878
  • Fax:
Mailing address:
  • Phone: 787-719-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JAVIE LOPEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-607-2574